The Characteristics and Roles of Medicaid-Dominated Managed Care Plans

This policy brief (Publication #2180) provides a national profile of Medicaid-dominated managed care plans – those in which Medicaid enrollees make up at least 75 percent of total enrollment. While recent policy and market forces have encouraged the growth of these plans, basic information about them has been lacking, partly because many are not licensed as HMOs by states. As of June 1997, 118 of these Medicaid-dominated plans served 3.4 million Medicaid enrollees across the United States – 36 percent of all Medicaid enrollees in full-risk plans. Using data from a subset of 15 high-volume Medicaid managed care states, the brief also presents analysis indicating that Medicaid-dominated plans tend to serve areas with greater concentrations of ethnic minorities, higher levels of poverty, and fewer health care resources.